Provider Demographics
NPI:1992714174
Name:ALLERGY AND ASTHMA INSTITUTE OF SE MICHIGAN
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA INSTITUTE OF SE MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-363-3232
Mailing Address - Street 1:27655 MIDDLEBELT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5029
Mailing Address - Country:US
Mailing Address - Phone:248-363-3232
Mailing Address - Fax:248-363-3455
Practice Address - Street 1:27655 MIDDLEBELT RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5029
Practice Address - Country:US
Practice Address - Phone:248-363-3232
Practice Address - Fax:248-363-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013420207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty